Proefschrift

Effectiveness of PWB in surgically treated trauma patients with peri- and intra-articular fractures of the lower extremities 87 evaluated by the physical therapist during every outpatient physiotherapy session. Clinical symptoms include the evolution of signs of inflammation, neuro-vascular status, weight-bearing tolerance, changes in the alignment of the affected side of the body, and the quality and function of the soft tissue and the joints involved. This progression in patients’ functional activities is determined from the quality of performance of a functional activity. The progress in therapy is not determined by any predetermined or fixed degree of loading of the affected side in kg or in percentage of body weight, as this has proved to be difficult to adhere to. This process enables patients to carry out the activities with normal/optimal motor skills as soon as possible. The approach is guided by the quality of performance and the safety of the activity (e.g. preventing stumbling). The next stage of the treatment is started when the gait pattern associated with the current stage of the treatment is optimally executed, and can be performed by the patient safely and independently.2 In the RWB group, the patients underwent a non-weight bearing regimen for 6-12 weeks followed by partial weight bearing with a 25% increase in weight loading every week according to the existing (AO) guidelines.1 Outcome measures and co-variables The patients’ self-perceived outcome levels, questionnaires related to the activities of daily living (ADL) were assessed as primary outcome measure. ADL was measured with the Lower Extremity Functional Scale (LEFS). The LEFS consists of 20 questions about a person’s ability to perform daily tasks. The score for each question ranges from 0 (extreme difficulty in performing the activity) to 4 (good performance of activity), maximizing the score at 80 points. The lower the score, the greater the disability.17 The other patients’ self-perceived outcome levels were assessed as secondary outcome measures, using questionnaires related to the quality of life and pain score. The quality of life was measured with the Short Form-12 (SF-12) questionnaire. The SF12 consists of 12 items that assess 8 dimensions of health: physical functioning, rolephysical, bodily pain, general health, vitality, social functioning, role-emotional and mental health. The SF-12 measures various aspects of physical and mental health from which a physical composite score (PCS) and a mental composite score (MCS) can be calculated, ranging from 0 to 100.18 The intensity of pain was measured with the Numeric Rating Scale (NRS; 0 indicating no pain and 10 worst pain).19 All patients’ selfperceived outcome levels were obtained at the follow-up time-points of 2, 6, 12 and 26 weeks post-surgery. The other secondary outcome measures were the rehabilitation outcome (i.e. outpatient physiotherapy, time to full weight bearing, completion of rehabilitation within 26 weeks), complications during a 26-week post-surgery follow-up and the progression of weight bearing during the first 12 weeks of rehabilitation.

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